Paediatric blast injury: challenges and priorities

Bull, Anthony M.J.; Mayhew, Emily; Reavley, Paul; Tai, Nigel; Taylor, Sebastian

doi:10.1016/s2352-4642(18)30073-7

Cited by 8 publications

(7 citation statements)

References 9 publications

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“…Following up recovery is a recurring theme when exploring long-term challenges of blast injuries in children 6. Children are a complex cohort to monitor.…”

Section: Resultsmentioning

confidence: 99%

“…However, paediatric care in conflict zones is often delivered by personnel for whom experience of dealing with paediatric blast injuries is unusual 5. Primary studies increasingly recognise the complex patterns of injury sustained in the adult population following blast exposure3; however, there is a lack of consensus as to whether applying lessons learnt from the adult population translates appropriately into paediatric cohorts 6. Bree et al 7 argued that principles for life-saving interventions, such as prioritising catastrophic haemorrhage, airway, breathing and circulation, are just as applicable in children as adults.…”

Section: Introductionmentioning

confidence: 99%

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Blast injuries in children: a mixed-methods narrative review

Hargrave

Pearce

Mayhew

et al. 2019

bmjpo

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Background and significanceBlast injuries arising from high explosive weaponry is common in conflict areas. While blast injury characteristics are well recognised in the adults, there is a lack of consensus as to whether these characteristics translate to the paediatric population. Understanding blast injury patterns in this cohort is essential for providing appropriate provision of services and care for this vulnerable cohort.MethodsIn this mixed-methods review, original papers were screened for data pertaining to paediatric injuries following blasts. Information on demographics, morbidity and mortality, and service requirements were evaluated. The papers were written and published in English from a range of international specialists in the field.ResultsChildren affected by blast injuries are predominantly male and their injuries arise from explosive remnants of war, particularly unexploded ordinance. Blasts show increased morbidity and mortality in younger children, while older children have injury patterns similar to adults. Head and burn injuries represent a significant cause of mortality in young children, while lower limb morbidity is reduced compared with adults. Children have a disproportionate requirement for both operative and non-operative service resources, and provisions for this burden are essential.ConclusionsCertain characteristics of paediatric injuries arising from blasts are distinct from that of the adult cohort, while the intensive demands on services highlight the importance of understanding the diverse injury patterns in order to optimise future service provisions in caring for this child blast survivor.

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“…Following up recovery is a recurring theme when exploring long-term challenges of blast injuries in children 6. Children are a complex cohort to monitor.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Blast injuries in children: a mixed-methods narrative review

Hargrave

Pearce

Mayhew

et al. 2019

bmjpo

Self Cite

View full text Add to dashboard Cite

show abstract

“…Irrespective of the type of conflict, just or unjust, disastrous, or victorious, all wars are regarded to be waged against children because armed conflicts often do not demarcate battlefields; instead, residential areas and schools nowadays are battlefields and children and women are the most vulnerable. 46 In a recent report by the Save the Children charity organization 47 about 357 million children (one in six) worldwide are living in conflict areas and exposed to the most severe forms of violence imaginable. These figures are believed to be up by 75% from previous records in the early 90s.…”

Section: A World Full Of Conflictsmentioning

confidence: 99%

Armed conflict, a neglected determinant of childhood vaccination: some children are left behind

Ngo

Pemunta

Muluh

et al. 2019

Human Vaccines & Immunotherapeutics

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Vaccination is an indisputable intervention that has tremendously mitigated the global burden of vaccine-preventable diseases (VPDs). The number of armed conflicts globally seems to be at an alltime high, with devastating effects on vaccination coverage. This paper will examine how armed conflicts affect childhood vaccination and lead to the reemergence and spread of VPDs. Unarguably, socioeconomic factors, population demographics, the apparent long vaccination timetable, multiple vaccine doses, lack of trust in vaccination processes and the rumor of the adverse effects of some vaccines unnerve some parents and create a puzzle. By bringing under the global floodlight, the impact of armed conflicts which contextually affect vaccination coverage, this article will help strengthen the advocacy for vaccination, and call for the fortification of existing treaties on the rule of engagement during conflicts. In order to eliminate or eradicate VPDs, strategies to reach children that are left behind during conflicts is paramount.

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“…However, only a few studies have focused on the treatment of blast injury in children. The pathological and physiological responses and subsequent treatment of children, especially young children, after shock‐wave injury are different from what occurs in adults . Similarly, children's lung tissue is undeveloped such that their pathological and physiological responses to BLI are different from those of adults.…”

Section: Introductionmentioning

confidence: 99%

“…The pathological and physiological responses and subsequent treatment of children, especially young children, after shock-wave injury are different from what occurs in adults. 2 Similarly, children's lung tissue is undeveloped such that their pathological and physiological responses to BLI are different from those of adults. For example, children's physiological and injury-related indicators undergo faster and more complex changes than those of adults, making treatment more difficult.…”

Section: Introductionmentioning

confidence: 99%

Comparison of blast lung injury in infant and adult rabbits

Yang

Cai

et al. 2019

Pediatric Pulmonology

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Background A great number of children suffer from blast lung injury (BLI) worldwide, but there is a little basic study on the topic. Methods Infant (4‐week‐old) and adult New Zealand rabbits were selected. Comparison of BLI characteristics: 16 infant rabbits were randomly divided into a 4.0 MPa group (n = 8, “IRG4.0MPa”) and a 4.5 MPa group (n = 8, “IRG4.5MPa”) and exposed to shock waves of those magnitudes. Eight adult rabbits were exposed to 4.0 MPa (“ARG4.0MPa”). The severity of BLI was compared among these three groups. Comparison of impact characteristics between infant and adult rabbits at the same scale of BLI: infant and adult rabbits were randomly divided into a control group (n = 8 per age group) and a blast injury group (n = 40 infants, “IRG4.0MPa”; n = 40 adults, “ARG4.5MPa”). The vital signs, physiological indicators, gross anatomy, and light microscope pathology were observed. Results The differences in lung injury severity and in abbreviated injury scale (AIS) scores between IRG4.5MPa (87.5%, AIS 4.13 ± 0.64) and ARG4.0MPa (75.5%, AIS 4.18 ± 0.75) were not statistically significant (P > .05); IRG4.0MPa (12.5%, AIS 3.38 ± 0.52) showed a lower proportion of lung injury and lower AIS scores than the others (P < .01). All rabbits showed languor immediately after the injury. The lungs showed tissue rupture, extensive patchy hemorrhage, edema, and inflammatory infiltration. The increase in lung water content was much higher in the IRG than in the ARG (P < .01). Conclusion Infant rabbits show better tolerance to lung injury caused by shock waves; infant rabbits show more disturbance on pathophysiological response than adult rabbits.

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Paediatric blast injury: challenges and priorities

Cited by 8 publications

References 9 publications

Blast injuries in children: a mixed-methods narrative review

Blast injuries in children: a mixed-methods narrative review

Armed conflict, a neglected determinant of childhood vaccination: some children are left behind

Comparison of blast lung injury in infant and adult rabbits

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